Enabling Meaning Innovation in Orthopedics (transcribed by Sonix)

Welcome to the outcomes rocket podcast where we inspire collaborative thinking. Improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers and now your host Saul Marquez

And welcome back to the podcast. Saul Marquez here And today I have the privilege of having Dr. Sharat Kusuma. He’s an orthopedic surgeon board certified and fellowship trained orthopedics and hip and knee. Now I will say this. He’s got an extensive level of experience. And today Sharon comes to us to express his thoughts and his opinions on health care with with several decades of experience in the space he’s gonna share a lot of great insights and I’m excited to have that conversation with him prior to doing what he does now. He was a senior engagement manager at McKinsey and Company and the health care provider provider payor pharma and medtech space. Over his career he had the opportunity to work deeply in nearly all areas of health care payers providers pharma Medtech managers and academia. So the conversation we’re going to have today is can be fun. It’s going to be dynamic and it’s going to be with an individual that’s had a breadth of experience that you guys are going to enjoy. So Surat with that intro I want to just welcome you to the podcast. Thanks for joining.

Thank you. Appreciate the opportunity to join. Yeah. I commend you on establishing this podcast. It’s a very cool topic to talk about.

Thank you sir.

Now that I miss anything in your intro that you would add or anything in general that you want to add to to how I opened about you I mean I mean the only thing I would share that that sort of this is funny in my in my short thus far business career of only four years now after having left clinical practice. The value of sort of having spent six or seven years after completing training is that what would you call an attending surgeon or an attending physician sort of in a foxhole right on the frontlines. That experience is so invaluable in terms of your at least in my opinion in terms of one’s ability to conceptualize and sort of deliver a real product that’s useful. So I had that experience and also very formative and critical for me so I would I would just add that the clinical experience was a huge part of my career and identity and also success in business as well.

So now really great call out. Sure I’m glad you brought that up and for sure you know a lot of a lot of decisions a lot of products are being innovated in healthcare in a vacuum. And then it shouldn’t be that way. So. So before we dive into the to the nuts and bolts here what got you into health care to begin with.

Yes I mean I have a pretty traditional story. I mean B and of course as you know first generation Indians a lot of I think the statistic is Indians are about less than 1 percent of the American population but are about 25 percent of physicians right. So we’re 25 times more. And so you know I came from a family my father’s a surgeon. My brother is a surgeon my cousin a surgeon. So you know sort of in my blood I suppose if you’re going to health care and I will tell stories of you know as a child admiring my dad you know getting up on weekends on Saturday morning to go make rounds and you know I love sitting and hearing him take phone calls and hearing words like hemoglobin I don’t know what that meant when I was seven years old I thought was cool that he’s calling my dad.

And so as always that is fascinated. And so yeah. And then of course the last story I’ll tell was very very formative for me. My dad made me work as an orderly in the operating room when I was in high school in the summer and as I was making mopping body floors and picking up dirty and that was an experience that really I just loved surgery I thought it was a cool thing to be able to you know manipulate the body in a short time and make it big. So yeah it was an easy decision for me and I loved my surgical career was an amazing amazing part of my life.

Sure it’s super cool that your dad did that and despite the mopping of blood and everything like that you still decided to stick with it. So that’s how I did that. That’s a testament to what you know drives you and that line that that’s been in your family and so what would you say today Sharon. You know you’ve had the opportunity to look at things as a clinician as a surgeon as as a consultant and as a tech you know side person now. Now what would you say as a hot topic that needs to be on every health leaders agenda and how would you approach it.

So pretty open ended question I suppose you’re saying sort of what are just general hot topics whether tack or not is what makes them kind of question.

Sure. For example today let’s just say for example health care leaders in the Provider space are running their system what do they need to be thinking about what’s the number one thing that you would do to a hospital show. This is important. That’s it.

That’s very helpful. And so are some of my answer will be a little bit sort of colored by my specialty isn’t with the surgeon. But I would say I’ll say two things right. And and the first one is going to be sort of the shift to outpatient surgery I know that’s a bit of a cliché that let me I’ll get a little more in the detail of sort of what’s driving that and how the how that can be a big trend that could go unnoticed by as you say sort of the standard hospital system administrator and leader is number one and number two I think improving you know again in the tech industry they have one of these terms UI you know user interface user experience. I think that UX component and I mean that sort of all of its manifestations are the two things. So I guess I can start with the first if you look at specialties especially such as Orthopedics. People know that for the last 20 years we’ve been doing things like arthroscopy and putting ligaments back in place and doing shoulder arthroscopy you know as an outpatient for many many years. And right. There’s nothing you know nothing new about that. They are done in ambulatory surgical centers for many many years. However if you told one of the leading hip and knee surgeons from 20 years ago that in 2018 we would be doing 3 to 4 percent and it depends on who you ask on the numbers. But it’s a number of this meeting. It’s not zero it’s not 50 but it’s certainly a measurable number.

We’d be doing 3 to 4 percent of total joints in this country in an in a building that is not in a hospital that’s separate from a hospital and they would think you’re absolutely crazy and you know that because you know 20 years ago people spent seven days in the hospital after a standard knee replacement. And what we’ve learned over the last say 10 to 12 years or so is that it’s actually entirely safe and a lot of the population to do a knee replacement in an AC and have somebody home for dinner. And of course there are some clinical benefits. We can talk about those but let’s not forget physicians and I’ll be very transparent and blunt in this interview. That’s OK. I mean just like all other and there’s no need to apologize for this. Physicians have financial incentives and motives and want to be successful financially just like anyone else. Any lawyers or investment bankers or device people. So the economics of the AFC total joint I’m glad to go in as much detail as we want are also driving physicians to move away from a hospital where they have very little control over the workflow and the economics into an AFC where they have almost complete control in any situation. So that’s trend number one that I think if I was a CEO of whatever Intermountain Health Partners Health Care you know whatever that I would I would consider a number one. The second thing on the UX and the UI for the patients and the doctors here’s what I mean by that taking knee replacements as an example.

Right. Or taking plastic surgery elective. You know what say you know cosmetic surgery is an example the way we practice medicine today as people come in for follow visits after the surgery simply by convention. Right I mean if you’re a sore you’re a healthy healthy young man and you know heaven forbid you need a hip replacement at your young age. But it does happen. And let’s say you let a couple hours away from my office. There’s no clinical need for me to have you come into my office that day a day 14 after surgery simply because you had surgery. I mean I could sure digitize that entire experience using a wearable and a camera and really improve. And so when I say you. I mean there are multiple roads we could go about I would say that there’s a lot of operational efficiency to be had. And in terms of patient satisfaction and what I find is that. And back to the whole clinical thing I don’t mean to sound paternalistic or in pain when I say this but I think you have to have a pretty rich clinical experience to know exactly what products you build how that would work in order to create value in that you are you actually you know there’s just no way you could know that unless you unless you’ve lived it. And so that’s where I think the two big sources of value are you know in surgical care which is a big component of expense for us. Right. And then 20 2018 2019. So those are my two sort of insights on that.

I think very very insightful Sharon. So thanks for for sharing that. Yeah. You know when we when we think about the user experience user interface and health care there’s definitely a lot of opportunity to think through process to think through location or should I or should I not go. Recently had had a guy from a firm that they said they looked at the 30 day readmit problem and they said rather than focus on the back 30 days. Why don’t we focus on the first 30 days before the surgery.

And that’s another day. I didn’t allude to that but yeah. Sorry to interrupt. That’s a no insight. When you talk more about that for sure but I’d love to hear the rest of your story.

Yeah. No no bottom line is this is like is going back to your point I just mentioned that one day illustrate this this interface this experience needs to be examined deeper right now. So anyway just to just to kind of carry on with your example that that one guest that I had on David Brown from Vox. Yeah. You know. Sure yeah. Taking a look at these things. Sharon you know just curious about what you’ve seen. Maybe there’s an example you want to talk about how it can. Can these leaders make things better. Maybe you talk about something that you’ve done.

So let me share with you. I mean I’ll give you a sort of a use case and I think it will immediately resonate with. So again I’ll talk about a subject near and dear to my heart which is now ubiquitous you know hip and knee replacement is something we do about a million point one point two million procedures in America a year. So everybody knows 10 people right there their aunts uncles grandparents you know maybe even their friends who’ve had this procedure. Let’s talk a little bit about how that works today. And I’ll just say even myself as a doctor I delivered this crappy user experience to my own patients and I have always wanted to make it better and not now. So I hope they have credibility that I have actually. So it was just kind of here’s how it goes right. So you know your saw Mark as young healthy man you had a childhood injury in your hip and you come into my office and you say hey Dr. Carson you know I want to I’ve had a lot of hip pain. I’m considering having a hip replacement. Well if you have a pretty standard experience today in terms of let’s say you show up at the office I’m a very busy hip replacements or hit knee replacement surgeon you’re going to walk in the office and I’m in my waiting room I’ll be sold you know 20 30 people and I will probably on average if you look at the numbers we’ll have five minutes to spend with you face to face given sort of how my workflow in my day is to actually talk to you maybe 10 right depending on how efficient I am.

I didn’t make the decision to make this huge decision whether or not you’re going to have a hip replacement which is a big decision right. It’s a huge thing to consider. Now of course you’ve been thinking about it as a patient yourself but I the doctor don’t have years of data about your mobility you know prior to coming to my office I just have your history that you give me over time. You understand. Does that cause that kind of makes sense. What I’m happy that I’m sharing and so on and so we make this decision and then OK we’re gonna schedule the surgery saw for 45 days from now. We’re doing that 45 days. The current UI UX is that you have very little contact with my office on a day to day basis. And I haven’t been through this. The listeners who’ve had friends or family who’ve been through something like a hip or knee replacement and this will immediately resonate but I’ll try to make it real for them. For others who don’t have that experience and that 45 days some say today is December 17th I’m going to do your surgery on whatever January 20 30. Right. In those days I don’t have a lot of engagement with you as a patient. And that’s tragic because this is an elective non emergency surgery right. You don’t get time. You know we’re not going to over five minutes. We’ve got all that time. We could use tech to be more specific momentarily to educate you to get you comfortable to measure you know measure all kinds of things.

And in our sort of traditional system we’ve essentially squandered that entire opportunity by simply doing a few steps and scheduling you for surgery and it’s just unfortunate. So part of my passion some of the work we’ve done to sort of try to use that time both before we see me in the office you know hopefully get a couple of years of data before I see you and then use that time and the 45 days before surgery to really make a better informed decision about number one should you have the surgery at all. And number two if you’re going to have it what can we do to sort of measure and optimize your free status as you alluded to earlier to have you have a better outcome afterwards. Right and I’m going to go into specifics depending on how specific you want to get but that’s some of the area whether you are you can really improve. And there’s again there’s just a lot of room for improvement there. Right. You want to get more specific on some some things or do you want to.

No. You know one I think I think that’s really good. And as we as we think through some of these things it’ll be interesting to to understand that. So have you have you run any process improvement around this and what results have you seen if you have.

Yes. So let me make again a real tangible example right. Yes. Part of the reason that people’s recovery. Let’s just say from a hip or knee replacement is considered by most people to be quote unquote difficult is really because they’ve had no sort of education or prep they did had some but not sufficient proper education prior to the procedure. So once some procedures done they sort of find themselves with all these unknowns right about you know how much is supposed to hurt how much am I supposed to walk on today today is my third day after surgery. I just got home. What can I do this morning. You know after I had breakfast can I walk 10 feet.

Can I what have you know in real time patients have so many questions that we have. So let me give an example. You can imagine a world and some of the work that we’ve worked on and this is all that sort of you know shared publicly as well. You know the Apple Watch has all these amazing functions where it can really pull you know sort of collect a lot of biometric you know called Digital biometric data on patients rights so for example again let’s go back to the example of Saul Marquez in my office.

You’re a healthy guy in your mid thirties who needs a hip replacement. What I can do. Let’s imagine a universe where you’ve been wearing a something like Apple Watch for the last two years. And I could immediately pull up your activity data and say Hey Mr. MARQUEZ I can see your activity trend over the last two years. It shows that you know you declined your number of daily steps on average by 5 percent per month over the last two years we’ve learned and this is obviously I’m guessing due to your hip pain. And we’ve also noticed that you don’t climb stairs as much as you used to. Two years ago and we’ve also noticed by the way that you know when you are climbing stairs your heart rate is higher than it used to be. So these are little data points to let me know that you are going to do well with hip replacement cause I can tell from the activity that you’re pretty restricted. Right. And then so that’s kind of that. So imagine that paradigm versus what I described to you earlier where you walk in my office and I have a five minute history and I look at an Air France a small procedure. You know that’s a whole different decision making right. Okay so then imagine the 45 days before the surgery leading up to the surgery instead of you doing a bunch of paperwork and you know filling out the forms and all that. We use a device like the Apple Watch to sort of measure your activity and also maybe we could digitize all the physical therapy that you’re going to do after surgery so that we can actually have the watch and the phone sort of teach you what it’s going to do what you’re going to do after surgery.

By giving you sort of reminders engagement things like that imagine a world where you’re spending that 45 days with activity tracking that’s helping you learn how to do the physical therapy you will do after your surgery. Right. I mean that that’s a that’s a new paradigm where we’re not wasting all that time and I’m actually using those 45 days to teach you everything you need to know through the you know there’s activity tracker plus that you know the content could be a content or simulation content with you just play on the phone. That’s a very different paradigm that we’ve had in the past. And then of course then after your surgery you now are very comfortable with their physical keyboard all your therapy exercises because you’ve been you know you’ve been doing them every day for the 45 days leading up to the surgery. And we’ve also been tracking your activity now to hear this from our cars. Look it’s 10 days since your surgery. You already improved your step count your share count by 50 percent over what you were doing a year and not give you data that helps you understand how much better you’re doing in our current workflow. That’s not at all what we do right.

Yeah. Okay I don’t know too much detail but help me make sense of it. Exactly. It’s a charade. It’s that it’s that wider picture the broader deeper picture of each patient as they walk into your door. Being able to make those more informed and thoughtful decisions that I think every physician I know every physician wants to make is just right on or of that I do it right now.

Exactly. I mean for example we know that today if you look at the published literature you know depending on who you read it I can tell you what my personal experience was between 10 to 25 percent of patients who have a knee replacement in 2018. Now I’m coming on 20 19 after surgery are not happy with their results. Now what a tragedy that is in 2018. We have this amazing technology that can you know our Delta Airlines can use an RFID tag on my luggage and track my bag. You know what building is the bag. Atlanta. Just an amazing world. We can’t do better than 20 to 25 percent dissatisfaction. I would argue that’s unacceptable. You know and you’re 2018 migration all these resources and so you know obviously would go in a lot of detail but those are the kind of things we can make better decisions. If we understood from a lot of the longitudinal activity tracking standpoint you know people who would do X activity are probably too find even the x ray may look bad and have arthritis by clinical exam the activity level is so good that they’re not going to be happy after surgery. Right. Do you see what I mean. Those kind of decisions we can make using you know and so I think delivering the promise of wearables and things of that nature is really going to require us to be thoughtful around pretty specific use cases like what I’m describing here with an actual tangible clinical value tied to a specific pathology as opposed to more general just sort of fitness apps and things like that right.

And again we can talk more in detail the level you’re interested loving and not think this is this is wonderful.

And you know folks we were diving into some of the ideas. You know what can we do to optimize that that you X that UI for patients and doctors ultimately better care is better business and we need to be doing more of that. And so I love your examples charade. And so every every successful person that I get the privilege to chat with also has a good set back story or two would love if you could share a time when you had a setback and what you learn from it that’s made you better gosh I read about a 10 hour.

We need to be your guest for the next.

It’s been a sort of a series of setbacks with a couple of intermittent successes in there that have been sort of you know gosh I kind of think where to start I. Let me just think for a moment if I may.

I mean I’ll give you sort of one professional sort of set back in the fold maybe resonate with people I’m guessing many of you don’t know your listener or sort of profile but I’m guessing you have a fair amount of clinician types and others in the medical industry many of my listeners. I’ll tell you my story. So when I decided to leave clinical practice. Now full time practice now coming on for you can’t believe this and for years already I mean I was a pretty busy practice. I was doing pretty well financially. I had five sales reps following me around every day and I felt like I was the man I was king of the hill. You know I’ve had a long wait with the patient etc. And you know what I left that you know probably for better or for worse crazily sort of walked away from that life and decided to go to the consulting firm McKinsey Company and start becoming a health care consultant. And I thought you know I can be just amazing. I get most of your listeners are probably applaud McKinsey and Company you know kind of one of the elite again by some clerical error I was able to get a job probably administratively. But I remember starting to essentially forget lateral move and this was a significant I mean I took a I know you’re a leader listeners will be shocked. I took an 80 percent pay cut 85 percent pay cut from. Yeah. So you know you can imagine. But not only that I was a 36 year 37 year old and I had a pretty successful career as a clinician and I go to this consulting firm to learn how to do consulting and I didn’t even really know what that was. When I arrived at the firm and here I now have to learn how to use Excel and PowerPoint and I have a boss who’s a 30 year old graduate from Harvard Business School telling me that my PowerPoint fonts are not corrected that my bullet points on.

I was like well you know just two weeks ago I was playing for my pelvis back together and they were bleeding you know that the blood was going to the ceiling and you know here we are. You know I’ll tell you this that there was a real setback in the sense that in my first six months or so I had all been using the basics now that a shoot and I had good board scores and I think he’s quite right I had a lot of success and I wasn’t going into an environment. Now what I’m saying is that the position as a position we have the benefit of sort of leading by authority in life and you’re right. When I’m in an office setting or I’m in an operating room because I have the white coat and because I have the license I can basically tell you to jump off a bridge and you’ll see a doctor that sounds right. I people people that it was a bit was a big setback for me to learn that in business and in consulting you can’t lead that way even though you may have the most knowledge and have spent the most time studying in business. You know everybody gets an equal vote. And so it took me a long time to learn. And so my first six months at my McKinsey were extremely discouraging and I thought What the hell have I done here. And so it just took a real sort of swallowing of pride.

You know surgeons have no shortage of big egos but you know there’s a really great learning experience to learn how to lead by influence and by you know by data and sort of letting people come to conclusions on their own rather than by trying to eat it to them or you know or instruct them because you have the license and the white coat. That was a big learning experience and that’s just one of many setbacks. I can you know I can share with you and have a great learning experience.

You know Sara and really appreciate you sharing that. And then I’m sure you could hear the listeners like why do you do that. What was he thinking. So maybe you could share so so why did you do it. What was your motivator for that move.

So you know I’ll tell you I mean even to this day you know again I’ve had a very short business career and I continue to learn every day. It’s been amazing. But my clinical life you know whatever the two to three thousand patients I operated on during my career is always going to be other than having a son and getting married having a family. The most meaningful experience of my life. I mean I have patients that I did surgery on nine years ago that still call me and say hey Sharon I just want to say hello. I mean it’s just amazing right. And so this has a moral. The reason I walked away from that was because at some point I realized that I couldn’t scale myself any more than my own individual number of hours in the day time the number of surgeries I could do in an hour and I could really affect greater change in the healthcare system and so I guess I had to call it arrogance or psychosis whatever going to do that to think that I could make a bigger impact on the health care system if I actually left the one to one one by one patient care workflow and sort of hopefully take I guess I took a bet on the fact that taking a big clinical body of experience and moving that over into business would allow me to affect a lot more people positively than me individually cranking out hip and knee replacements every day. That was really sort of the motivation and the moral authority that end of the story still not known yet but so far it’s been a great journey but hopefully that answers your question. You know I definitely still do miss operating but but it’s been a great learning experience as well. You know I feel fortunate to have been able to work at some great places and get some of these great experiences in business.

Sharon what a great what a great story and thanks for for answering that. Absolutely. You’ve taken that leap of faith. I know that with the work the early work you’re doing you’re seeing results and your impact will definitely be expanded so kudos to you and for the listeners thinking about this move. Hey it’s not a bad move. You just have to be. You just have to be patient vigilant be willing to work through the downs and truck away. But ultimately a good inspirational story based all right. Thanks for sharing that.

And make it less. Yes. You know as was hearing you talk I mean one last thing I would say is that you know the business side of health care you know wave if you follow the insurance market and the medical device. I mean those companies don’t have enough odds to come clean here. Enough clinicians who sort of understand the day to day challenges of taking care of patients. And so I guess I just make a plea that the health tech industry and the payor industry and the med device industry is in desperate need of folks who are sort of willing to take this amazing body of clinical work that they’ve done and bring it over and will be a hard transition. But I think it’ll be worth it because the industry needs it so to develop products that that actually are meaningful and useful. The industry desperately needs it. So and certainly that certainly did that wearables sort of device industry. You know you can see that we’ve we’ve not really proven the use case yet right. The promise of wearables are gonna cure cancer and all things that ail humanity we certainly aren’t there yet. Right. So I think having some more clinicians to that work will help us create better products.

So there you have it listeners. A call to action if you’re a clinician looking to get into the business and also if you’re a business leader looking to make a bigger impact. Taking a look at clinicians as collaborators into the projects that you have gone on. Sharon what about one of your proudest leadership moments you’ve had and health care. What is it.

So let’s see again you like that it’s been a series of failures with a couple of sprinkles successes in. I’ll try to think of a I mean I think I have to say my proudest moment was probably you know on on October 15th of this year. I think it was a Tuesday or Monday. I remember we had the big press release of the the Zimmer bomb and Apple kind of collaboration. It was really it was just an amazing thing to be able to sit back and sort of celebrate the success of what we created. You know this the sort of clinically meaningful product that actually has it has a use case and you know again if you read if you read their press release and we’re doing this gigantic clinical study using the app that was built and you know it was just an awesome moment to be able to be part of a team you know sort of collaborating to companies with you know very different sort of DNA right if you think about a consumer electronics company versus a traditional med device you know it’s kind of divergent personalities. And I’ve been I’ve been able to be a contributor to that effort and be a part of that team that sort of got that product built in a pretty short time and built this clinical study that’s really designed to show that a clinical benefit right in a way that other clinical studies have not done. That’s pretty awesome. You know that was a pretty satisfying satisfying moment. It was pretty great.

That’s cool yeah. You know you’re moving the needle charade in your in your mission. You know four years ago you wanted to make a broader impact and you’re definitely moving the needle home with that project. And so and in many other ways. So I give you big kudos for that and starting to see the fruits of your labor come to fruition. What would you say an exciting project or focus you’re working on today is so so moving forward.

You mean in the car. Mean currently at the moment.

Yes. Yeah I mean some other things that I have a very very strong interest in. And this will get a little bit technical but I hope you’ll you’ll find it interesting and the listeners will as well. Again you know I spent a significant part of my life sort of learning orthopedics and learning how to put hip and knee replacements in people and you know for the listeners who maybe don’t know a lot about that topic if you sort of think about the way we implant it let’s just let me I guess let me give an analogy. I don’t know a lot about the auto industry from what I understand you know robotics and sort of you know automation to be able to improve the quality and the speed delivery of the car on the assembly line has come. Light years since the 1970s and 60s and 80s you know. And same thing in orthopedics believe it or not. Essentially today in 2018 we still do hip and knee replacements more or less the same way we’ve done them and this is I’m talking about inside in the surgery itself right. During the operation or that we did in 1985. We haven’t changed things all that much. It’s pretty shocking right. That’s a 33 year period where we still use sort of not to get over it but we use manual sort of instruments and we sort of eyeball things and you know you could argue that given all the technology we have that’s insane right.

Yes that’s.

So you know some of stuff I’m very passionately working on is I am interested in sort of using various types of sensors and and I get I can get as technical as you think that listeners will be interested in proving our ability. So give me an example. So again if you’ve ever watched a hip or knee replacement the way we do a knee replacement right you open the knee and then you you’re doing woodwork right you’re making phone cuts and then sort of cementing on these components in the way we do it now is we essentially use eyeball your eyes and we sort of open up. Look at the size of the patients you know the thigh bone and the shinbone. And when you do some sort of imagine sort of specialized rulers right essentially they’re like little measuring tapes that we use that are all manual and we measure front to back and side to side how big someone’s knee. And we say OK it’s about a size 4 it sounds I’m guessing for you and most of the listeners it sounds massively archaic. And not only that. The other thing that’s complex remember when we do a knee replacement we’re taking out sort of the bone that that was that we biologically you know that was sort of that we were born with and that grew over the years and we’re replacing it with metal and plastic implants. Remember we also have structures inside the knee that called ligaments right that are like the ACL you probably heard of many sports athletes have injured and we have other ligaments inside the knee.

Well believe it or not in 2018 2019 we don’t really have many great systems that help us sort of digitize what I described you as sort of a visual function of measuring you know the measuring tape the front the back side to side dimensions of the knee. Nor do we have any kind of electronic sensor that tells us what the ligaments will how they will behave after the knee replacement. Contrast that with your you know your Jeep Cherokee or your latest edition Audi A6 that has a sensor that can tell you when you write it. If you think about that right away it’s amazing that we have all this technology so one of my big passions is impressed using sensors and when I can be sensitive you know pressure sensors and electronics and sort of navigation systems that allow us to sort of paint the knee with you know imagine taking a scanner like so again and putting the knee on a scanner and then getting the size digitised and then having the exact dimensions of the implant and also being able to tell in real time similar to the way that four four wheel drive vehicle can go into snow mode versus dry road doing that in real time and then putting the implants and based on that. That’s some of the stuff that we’re working on and then secondarily to tie this back to sort of the the the the wearables world.

What better way to determine how much better people do after sort of this new way versus the old you know carpentry you know kind of method and then putting an accurate activity tracker like an Apple Watch on somebody and then having to grow if you have one group of patients that had the old way of putting it in and one group has a new way putting it in and within 60 days of walking around and tracking their activity we can prove whether or not Group B that had the new methodology of implantation using the sensors and the you know the digitized scanning of the knee versus group a we can tell immediately that group B is walking faster more steps a day you know it’s very quantitative so that’s some of the stuff that is pretty interesting and I think will allow us to sort of go to the next level of patient satisfaction and patient activity after these operations that traditionally people thought well my life is over right I can’t I’m going to be better I don’t have any replacement I may be pain free but I’ll be you know I’ll be sitting in a recliner right watching the price is right for the rest of my life. We hope we can change that. Where people can actually go back to doing sports and doing you know doing more activity because the knee is positioned so much better in three dimensions than we could previously do. Is that some of the stuff.

I hope that’s not too geeking out too much but you can tell adding stuff that us up.

I really find interesting and it is real right stuff that we’re actually building now and hopefully soon we’ll have deliverables where we can implant them that way. So pretty exciting.

No. That is and you know that that number that you mentioned earlier in the episode 20 25 percent dissatisfaction. Love that you’re hyper focused. Changing that then and also broadening your impact through your work. So this has been a ton of fun charade. I really really have enjoyed our time together. If you can I’d love it if you could just share a favorite book and then a closing thought then we could wrap it up so let’s see.

Favorite book. I do pride myself of being somewhat of an avid reader so I think the book that most recently has had a big impact on me. There’s a book called An American sickness that was written I forgot the physician who wrote it. The listeners can look it up and it’s essentially a book that talks about all the perverse incentives in a man. I’m not going to call out nine realize this is a big audience. Probably this is this I want to call it any particular industries or anything but it just talks about sort of how this American health care system as you know we spend upwards of 20 to 20 percent of our GDP on health care and yet our life expectancy is actually declining not going up. But what we’re spending this book really in a way that I’ve not seen with other books sort of lays out for you know for folks who want to understand better why is why are insidious sort of incentives perversely set up to sort of increase cost but not really deliver the value that we should. It lays it out in a way that I think the lay person can understand very well. So it’s just a great read and I get I can look up the name of the author. It’s called An American sickness. It was published in 2016 I think. And it’s just a great read on the topic of why our costs are so out of control and what patients can do. What consumers of healthcare can do to improve. You know because I guess I’m sort of a little cynical I think the consumer is going to have to be the one that changes healthcare. I don’t know any of our current industry players will do it in the way that a consumer could do it.

So it’s a good college for an American sickness folks take a take a read of that. I had a couple of other guests recommend a bitter pill which is in the same kind of process so definitely one that I’ll add to my list charade. Thank you for that. Listeners go to outcomes rocket dot health and look up Surat that’s S H H R A T Q consumer KUSI USA and you’re going to find it in there type type it in the search bar Surat you’ll find the entire transcript as well as links to the things that we’ve discussed.

Surat give us a closing thought and send us home and I mean closing thought as I will say is the following. Having had the chance to work at Apple and consumer electronics is just amazing and just computing in general how much does products have improved what people in health care talk a lot of why.

I’ll say wine a lot about margins and declining prices for drugs and implants and things. But if you sort of look at the computer industry as an alternate universe think of the amount of value they’re delivering the amount of innovation they’re delivering it essentially a declining cost. Year after year after year yet they continue to be profitable. I would argue that in healthcare you know we should have more of a view of we to innovate our way to better more cost effective solutions and stop whining about margins a bit because the airplane industry the computer industry is complex pretty amazing things in terms of computing speed and safety of taking a flight. Now I would love us in the healthcare industry to have a little more of a kind of a view of not whining about our margins and really innovating our way to better products for people you know and so that’s that’s sort of my impassioned message.

So it’s a great message Sharon and folks so let’s take these words and turn them into action because they’re definitely some heartfelt and action focused thoughts by Dr Sharon could soon someone. So sure I just want to say a final thank you for joining us and really looking forward to staying in touch with you.

Awesome thank you for that I appreciate the opportunity. Great. I commend you for having these topics on this podcast. That’s great.

Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes resources inspiration and so much more.

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